title: The modified Fontan operation for children less than 4 years old.
abstract: Of 500 patients who had a modified Fontan operation at this institution between 1973 and 1987, 54 (33 boys and 21 girls) were less than 4 years old. This retrospective study related preoperative clinical and hemodynamic data to subsequent survival. Twenty patients less than 4 years old had tricuspid atresia, 13 had double inlet ventricle and 21 had other complex heart defects. There were 14 early deaths (less than 30 days after operation) and 6 late deaths. Multivariate analysis of survival for the entire group of 500 patients revealed the following factors to be significantly associated with poorer survival: absence of tricuspid atresia (p = 0.011), asplenia (p less than 0.001), age less than 4 years at operation (p = 0.042), atrioventricular valve dysfunction (p = 0.017), early calendar year of operation (p less than 0.001) and the presence of either one or more of the following: left ventricular ejection fraction less than 60%, mean pulmonary artery pressure greater than 15 mm Hg and pulmonary arteriolar resistance greater than 4 U.m2 (p less than 0.001). On the basis of this study of 500 patients, age less than 4 years at operation appears to be an independent risk factor for poorer survival after the modified Fontan operation.
authors.affiliation: Section of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota 55905.
authors.forename: D A
authors.initials: DA
authors.lastname: Bartmus
authors.forename: D J
authors.initials: DJ
authors.lastname: Driscoll
authors.forename: K P
authors.initials: KP
authors.lastname: Offord
authors.forename: R A
authors.initials: RA
authors.lastname: Humes
authors.forename: D D
authors.initials: DD
authors.lastname: Mair
authors.forename: H V
authors.initials: HV
authors.lastname: Schaff
authors.forename: F J
authors.initials: FJ
authors.lastname: Puga
authors.forename: G K
authors.initials: GK
authors.lastname: Danielson
mesh_terms: D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006330:Heart Defects, Congenital / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis